Page 19 - Nov Dec 2015

DONATION FORM

I would like to support the Texas Police Association.

Name of Donor:

Address:

City: State: Zip:

E-Mail Address:

Enclosed is my donation for the Texas Police Association in the amount of:
$25.00 $50.00 $100.00 Other $

Enclosed is my check.

Please charge my Am Exp Discover Master Card Visa

Card #:

Expiration Date: 3 Digit Security Code:

Name on Card:

Signature:

Contact Phone Number:

Please mail forms and checks to:
Texas Police Association
P O Box 4247
Austin, Texas 78765-4247
Or
www.texaspoliceassociation.com

NOV/DEC 2015 www.texaspoliceassociation.com • 866-997-8282 15